Trihealth pavilion membership cost 2026

1. Click ‘Get Form’ to open the trihealth pavilion membership cost document in the editor.
2. Begin by entering your name in the designated field where it states 'print member/participant name'. This is essential for identifying your authorization.
3. In the section that requests information about the person or organization authorized to receive your health and exercise information, fill in the physician practice name, street address, city, state, and zip code.
4. Indicate whether you authorize the disclosure of your information by checking the appropriate box. Make sure to review this carefully as it determines who can access your data.
5. Sign and date the form in the provided signature fields. Ensure that a witness also signs and dates the document as required.
6. Finally, print your name clearly in the space provided below the witness signature line to complete the form.

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